Editorial: Disparities in mental health

Editorial on the Research Topic
Disparities in mental health

Health inequities not only pose an economic burden but also challenge social justice principles. While much of our understanding of health disparities focuses on physical illnesses, mental health is particularly susceptible to discrepancies. Addressing mental health issues requires trust, cultural sensitivity, acceptance, and support from healthcare providers. Individuals facing mental health challenges encounter disparities akin to physical illnesses and additional obstacles like societal stigma and language barriers. Identifying specific areas of mental health inequity, determining affected demographic groups, and assessing policy effectiveness are crucial steps to reduce disparities and promote well-being.

Research Topic of Mental Health Disparities in the Journal of Frontiers in Psychiatry explores various aspects within diverse social groups, aiming to elucidate current discrepancies, identify determinants, and propose mitigation strategies. Disparities manifest in various forms, including race, gender, sexual identity, LGBTQ+ populations, age, disability, socioeconomic status, and geographic location.

This Research Topic aims to inspire, inform, and provide direction and guidance to researchers in this field (Table 1). Each paper specifically addresses a practical point for researchers to consider as they seek to expand their knowledge in the realm of mental health disparities.

Table 1

Table 1 Articles in the Research Topic of disparities in mental health.

Various vulnerable populations are at an increased risk of mental health disorders such as depression and suicide. Particularly concerning suicide, it stands as the second leading cause of death for U.S. adolescents, with those in the juvenile legal system (JLS) being up to three times more susceptible. This crisis disproportionately affects Black and Latinx youth. A comprehensive approach involves diverting individuals to community treatment, preventing mental health deterioration during detention, supporting reentry post-detention, and assisting youth with mental health needs to prevent violations and new offenses. Addressing these intercepts is crucial for mitigating suicide risks in this vulnerable group (Meza et al.).

Contrary to the beliefs of the general population, physicians, also considered a vulnerable population, face an elevated risk of depression and suicide, a risk that becomes evident during medical school. Medical students exhibit higher rates of depression and suicidal thoughts than peers in other disciplines. Carlos et al. investigated mental distress and risk factors among US medical students, identifying poor sleep quality, impostor feelings, stress, and financial distress as key factors. Besides physicians, You et al. reported that Chinese nurses experience a moderate level of work alienation, marked by detachment from work due to infection risk, heavy workload, and persistent stress with consequences for both the individual and the organization. Recognizing this extent helps raise awareness among healthcare managers about the prevalent issue of work alienation among nurses and ensures the right for medical students to receive care for treatable mental health conditions.

Sex-specific differences, and disadvantaged sociocultural and economic status correlates with a higher prevalence of mental health issues including depression. Sex-specific differences are evident in depression, impacting clinical presentation, disease progression, and treatment response. Depression, affecting about 5% of adults globally, emerges as a common psychiatric issue. Associations between depression and risk factors vary by gender (Tseng et al.). When it comes to depression in the elderly, Hu et al. conducted a study in China to measure socioeconomic factors influencing depression in older adults living alone versus those living with others. The data revealed a higher prevalence of depressive symptoms in older adults living alone, primarily due to differences in socioeconomic status, marital status, years of school, self-reported local income, sleep, and health. Addressing these factors is crucial for developing targeted intervention strategies to improve the mental well-being of older adults at higher risk.

Moreover, disadvantaged sociocultural and economic status can impact mental illness treatment, particularly the psychosomatic rehabilitation sector, dedicated to preventing, treating, and compensating for chronic mental disorders. To detail inequalities in German psychosomatic rehabilitation, Kleineberg-Massuthe et al.‘s study reveals variations among patients from different social milieus concerning psychological symptom severity, psychosocial impairments, and treatment outcomes. Alongside structural care improvements, adapting and communicating services in ways more appealing to individuals from diverse social environments may be essential.

Targeted and customized mental health interventions are crucial for specific populations, aiming to enhance both their medical and psychiatric well-being. One such group facing notable health disparities is individuals with severe mental illness (SMI), leading to inferior outcomes and reduced life expectancy. Their oral health is notably worse, with a 3.4 times higher likelihood of complete tooth loss than the general population. While behavioral support interventions are generally effective in improving oral health behaviors, interventions for those with SMI encounter various challenges. Mishu et al.‘s study explores barriers and facilitators to oral health intervention engagement from the perspectives of people with SMI, caregivers, and service providers.

Turning attention to another demographic, it’s noteworthy that up to 25% of recognized pregnancies culminate in Early Pregnancy Loss, commonly referred to as miscarriage. This often precipitates enduring negative mental health responses, encompassing depression, anxiety, and Post-Traumatic Stress Disorder. Mendes et al.’s study pointed out that while clinical perinatal grief and PTSD scores significantly declined, a substantial number of women still experienced persistent clinical morbidities three years or more after the loss. Hence, timely monitoring and persistent intervention are crucial for those in need.

In a related context, approximately 4 million people with end-stage renal disease (ESRD) rely on renal replacement therapy, predominantly through maintenance hemodialysis (MHD). Studies highlight that socio-environmental, psycho-spiritual, and clinically relevant factors contribute to diminished health-related quality of life (HRQoL) in young and middle-aged MHD individuals. Nurses should develop tailored intervention programs, focusing on targeted counseling and health education strategies to address these factors and improve HRQoL (Mai et al.).

Another crucial aspect highlighted in the literature is the exploration of the connection between chronic conditions and mental health disorders. In this context, approximately 80% of individuals over 65 years old affected by multiple chronic conditions (MCC) experience impacted physical well-being, increased treatment costs, and are prone to psychological challenges such as depression, anxiety, and stress. Also, they exhibit a higher prevalence of alexithymia, affecting communication, disease management, recovery, and overall quality of life. Shang et al.’s study emphasizes Difficulty Identifying Feelings (DIF) as a significant psychological challenge, with the highest centrality and predictability across various alexithymia levels. Addressing the DIF tendency in older adults with MCC may improve other dimensions of alexithymia and alleviate symptoms of depression and anxiety in such communities.

In the realm of kidney care, individuals with severe mental health disorders (SMHDs) such as schizophrenia, bipolar disorder, and major depression face increased challenges. Cogley et al. brought to light additional barriers to kidney care for those with SMHDs, encompassing mental health challenges, motivation issues, cognitive difficulties, and mistrust of the healthcare system. Achieving effective kidney care requires an integrated “whole person” approach addressing the interplay between kidney disease and mental health.

Last not least there are papers investigating potential impacts of global trends and demographic shifts including COVID-19 pandemics, aging and the LGBTQ community, on mental health conditions. Chen et al.‘s US study during COVID-19 reveals a 2.27 times higher risk of unmet mental health needs (UMHNs) in LGBTQ+ individuals compared to non-LGBTQ+. Additionally, concerning associated socioeconomic factors, LGBTQ+ individuals are more likely to be younger (p < 0.001), unmarried, non-White, have lower education, lower household income, financial difficulties, and lack public and private insurance.

In parallel, another research study addressed the affected quality of life (QoL) due to life events during gender transition in transgender individuals. Garcia Nuñez et al.’s study on 30 transgender individuals highlighted significant mental health challenges, with psychological distress double that of cisgender norms. Trans individuals showed mental domain impairments in QoL, correlated negatively with life event impacts and psychological distress. Therefore, an integrative psychosocial support framework is essential, emphasizing that medical transition should not be isolated but considered holistically.

Finally, aging, as a global demographic challenge, can be associated with various cognitive and psychiatric disorders such as dementia, depression and suicides. Globally, the aging population is on the rise, with projections indicating that by 2050, individuals aged 65 and over will make up 24% and 21.4% of the UK and US populations, respectively. The health and well-being of older adults are significant policy priorities, and perceived discrimination is increasingly recognized as a risk factor for compromised healthy aging (Amirova et al.).

Studies presented here are of 14 published studies of Frontiers in the Research Topic of “Disparities in Mental Health”. It is to be hoped that many interesting scientific results will be reflected in mental health disparities worldwide.

Author contributions

MM: Validation, Writing – original draft, Writing – review & editing, Investigation. HKo: Project administration, Supervision, Validation, Writing – review & editing. FM: Conceptualization, Data curation, Methodology, Supervision, Validation, Writing – review & editing. HKa: Writing – review & editing. LH: Supervision, Writing – review & editing.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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